Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg.
Psychol Health Med. 2012;17(5):599-610. doi: 10.1080/13548506.2011.648201. Epub 2012 Feb 7.
Neurodevelopmental delay has been documented in up to 97.5% of HIV-infected children in Soweto who were not yet on antiretroviral treatment (ART). With growing numbers of children in South Africa being successfully treated with ART, the effects of ART on neurocognitive functioning in children require investigation. The objective of this study was to determine the extent of neurodevelopmental delay in stable HIV-infected preschool children (aged five to six years) receiving ART and compare it to an apparently healthy (unconfirmed HIV-status) group of preschool children. Thirty HIV-infected preschool children (virologically and immunologically stable on ART for more than one year) were conveniently sampled from 350 eligible children on ART at the Harriet Shezi Children's Clinic in Soweto, Johannesburg. The comparison group comprised 30 well-nourished preschool children attending the Lilian Ngoyi Primary Health Care Clinic in Soweto for routine immunizations. Each child was assessed using the Griffiths Mental Development Scales-Extended Revised Version (GMDS-ER), at a single point in time. The overall developmental z-scores on GMDS-ER were <-2 (indicating severe delay) in 27 (90%) children in the HIV-infected group compared to 23 (76%) in the comparison group (p = 0.166). Mental handicap (overall GQ < 70) was evident in 46.7% of children in the HIV-infected group compared to 10% in the comparison group (p = 0.002). There was a 7.88-fold increased likelihood of severe delay in the HIV infected group. The HIV-infected group and comparison group had significantly different (p = 0.001) mean overall GQ scores of 70 (95% CI: 66.0-74.0) and 78 (95% CI: 75.6-80.5), respectively, with lower mean scores in the HIV-infected group in all individual domains. Early initiation of ART in HIV-infected infants may improve cognitive functioning among this group; however, intervention strategies which optimize early cognitive development for all children in the area need to be urgently considered.
在未接受抗逆转录病毒治疗（ART）的索韦托感染艾滋病毒的儿童中，有高达 97.5%的儿童存在神经发育迟缓。随着越来越多的南非儿童成功接受 ART 治疗，ART 对儿童神经认知功能的影响需要进行调查。本研究的目的是确定在接受 ART 治疗的稳定期 HIV 感染学龄前儿童（5 至 6 岁）中神经发育迟缓的程度，并将其与一组明显健康（未经确认的 HIV 状态）的学龄前儿童进行比较。从约翰内斯堡索韦托哈里特·谢齐儿童诊所的 350 名接受 ART 治疗的符合条件的儿童中，方便地抽取了 30 名接受 ART 治疗的 HIV 感染学龄前儿童（在接受 ART 治疗一年以上后病毒学和免疫学稳定）。对照组由 30 名营养良好的学龄前儿童组成，他们在索韦托的利利安·恩戈伊初级保健诊所接受常规免疫接种。每个孩子都在一个时间点接受了格里菲斯精神发育量表扩展修订版（GMDS-ER）的评估。在 HIV 感染组中，有 27 名（90%）儿童的 GMDS-ER 总发育 z 评分<-2（表明严重迟缓），而对照组中则有 23 名（76%）（p=0.166）。在 HIV 感染组中，有 46.7%的儿童明显存在智力障碍（总体 GQ<70），而对照组中则有 10%（p=0.002）。在 HIV 感染组中，严重发育迟缓的可能性增加了 7.88 倍。HIV 感染组和对照组的总平均 GQ 评分分别为 70（95%CI：66.0-74.0）和 78（95%CI：75.6-80.5），差异有统计学意义（p=0.001），HIV 感染组在所有单项领域的平均得分均较低。早期为 HIV 感染婴儿启动 ART 可能会改善该组的认知功能；然而，需要紧急考虑针对该地区所有儿童的优化早期认知发展的干预策略。
